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首页> 外文期刊>Circulation journal >Decreased Defibrillation Threshold and Minimized Myocardial Damage With Left Axilla Implantable Cardioverter Defibrillator Implantation
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Decreased Defibrillation Threshold and Minimized Myocardial Damage With Left Axilla Implantable Cardioverter Defibrillator Implantation

机译：左腋下植入式心脏复律除颤器植入可降低除颤阈值并最大程度地减少心肌损伤

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Background: To reduce myocardial damage caused by implantable cardioverter defibrillator (ICD) shock, the left axilla was studied as an alternative pulse generator implantation site, and compared with the traditional implantation site, the left anterior chest. Methods?and?Results: Computer simulation was used to study the defibrillation conduction pattern and estimate the simulated defibrillation threshold (DFT) and myocardial damage when pulse generators were placed in the left axilla and left anterior chest, respectively; pulse generators were also newly implanted in the left axilla (n=30) and anterior chest (n=40) to compare the corresponding DFT. On simulation, when ICD generators were implanted in the left axilla, compared with the left anterior chest, the whole heart may be defibrillated with a lower defibrillation energy (left axilla 6.4 J vs. left anterior chest 12.0 J) and thus the proportion of cardiac myocardial damage may be reduced (2.1 vs. 4.2%). Clinically, ventricular fibrillation was successfully terminated with a defibrillation output ≤5 J in 86.7% (26/30) of the left axillary group, and in 27.5% (11/40) of the left anterior group (P<0.001). Conclusions: Clinically and theoretically, the left axilla was shown to be an improved ICD implantation site that may reduce DFT and lessen myocardial damage due to shock. Lower DFT also facilitates less myocardial damage, as a result of the lower shock required. ( Circ J 2016; 80: 878–886)
机译：背景：为了减少由植入式心脏复律除颤器（ICD）休克引起的心肌损害，研究了将左腋窝作为替代的脉冲发生器植入部位，并将其与传统的植入部位左前胸进行比较。方法和结果：计算机模拟被用来研究除颤传导模式，并估计当脉冲发生器分别放置在左腋窝和左前胸时的模拟除颤阈值（DFT）和心肌损伤。脉冲发生器也被新植入左腋窝（n = 30）和前胸部（n = 40）以比较相应的DFT。在模拟中，当将ICD发生器植入左腋窝时，与左前胸部相比，整个心脏可能会以较低的除纤颤能量进行除颤（左腋窝6.4 J与左前胸腔12.0 J），从而心脏比例心肌损伤可以减少（2.1％对4.2％）。临床上，左腋窝组的86.7％（26/30）和左前壁组的27.5％（11/40）的除颤输出≤5J成功地终止了心室纤颤。结论：在临床和理论上，左腋窝被证明是改善的ICD植入部位，可减少DFT并减轻休克对心肌的损害。较低的DFT还可减少所需的电击，从而减少对心肌的损害。 （Circ J 2016; 80：878–886）

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